Find answers to your questions

Enrollment

An individual is eligible for a Special Enrollment Period (SEP). Do I need to submit anything to enroll them?

We require supporting documentation that outlines the specific SEP and whether the Member qualifies. The required information may vary depending on the nature of the event.

If you are unsure what supporting documents you need to provide, please contact our Member Services Department for assistance at (855) 624-6463, select option 1, then choose option 5.

Tax Forms

When will I get my 1099?

1099 Forms are mailed to brokers prior to the end of January each year.

Eligibility

What are your eligibility guidelines for group plans?

To be eligible as an Employer Group, there must be at least one eligible common law employee who is receiving a W-2, who is not an owner or spouse of an owner, and is working a minimum of 30 hours per week. Sole Proprietors and groups composed only of an owner and spouse are not eligible for a group plan and must enroll on the Individual Market. An eligible group must be headquartered in Maine. It cannot have more employees in any other state than are employed in Maine to be eligible for coverage with Community Health Options.

What is the difference between a Small Group and a Large Group?

Group size is determined by the number of Eligible Employees (EEs). An employer with 1 to 49 EEs is considered a Small Group and will be community rated. Any Employer Group with 50 or more EEs during the prior calendar year is considered a Large Group, will receive premium rates based on the group’s claim experience, and will be medically underwritten. Groups with 50 or more EEs may also be considered an Applicable Large Employer (ALE) by the IRS and be subject to specific reporting requirements. Visit the IRS website for more information about determining if your business is an ALE.

How many plans can an employer choose for their employees?

The number and variability of plans you may select for employees to choose from are limited by the number of enrolled employees.

  • 1 – 10 Enrolled Employees: 2 plan options, with no more than a $3500 spread in Deductible
  • 11 – 19 Enrolled Employees: 2 plan options, with no Deductible spread limitation
  • 20 or more Enrolled Employees: 3 plan options, with no Deductible spread limitation

Working With Us

I am taking over an existing Health Options client on a Broker of Record (BOR). What do I need to do?

For commissions to be paid to a new broker who is taking over an existing enrolled employer, the broker must obtain a signed Broker of Record Letter from the employer group. Submit the letter directly to your Account Manager in our Business Development Department to have the change processed.

When do you pay commissions?

Commissions are paid to appointed brokers no later than the end of the month for any commissions earned for the prior month.

What do I do if I have a question on my commissions?

Please email BusinessDevelopmentInfo@healthoptions.org, or call (207) 402-3353.

How do I inquire about becoming appointed with Community Health Options?

Please contact our Business Development Department directly at (207) 402-3353 or email BusinessDevelopmentInfo@healthoptions.org.

Who do I contact if my client has an issue that needs to be resolved?

If you need assistance with an Individual Member, please contact Member Services at 1 (855) 624-6463 then select option 1, then select option 5. For assistance with a Group client, please contact your Account Team in our Business Development Department at (207) 402-3353.

Who do I contact for assistance with the Broker Portal?

Please contact any Account Team member in the Business Development Department at 207-402-3353.

Interoperability

What is interoperability?

Interoperability in healthcare is the ability for information, in the form of data, to be shared and used among doctors, laboratories, hospitals, pharmacies and the consumer/patient. The goal of sharing healthcare data within the health service industry is to create a more effective and efficient means to provide quality care by enabling quicker and more informed decisions.

What does interoperability mean for me?

It is important for Health Options Members to know that you control your health-related data sharing through health applications, like exercise trackers, which you must choose to connect through your smartphone, tablet, etc. If you choose not to share your access – your information remains private. You turn data sharing on and off via your health and wellness application on your personal device. If you don’t download an app and turn on permission, nothing changes.

What do I need to know before I connect an app?

If you choose to connect health care provider or commercial health tracking apps, you are placing a copy of your personal health information/data outside of Health Options' systems and data protections. This information includes, but is not limited to, your name, date of birth, health insurance plan information, healthcare providers you have seen, claims made for medical, pharmaceutical and laboratory visits, and other data.

You must contact the organization or business that created your app for information about how they will protect, share, or sell your data. It’s important to remember that not all organizations or individuals are covered by health information protection (HIPAA) regulations. Read more about HIPAA here: https://www.hhs.gov/hipaa/index.html. To learn more about your rights related to online data access, visit the Office of Civil Rights here: https://www.hhs.gov/ocr/index.html and the Federal Trade Commission here: https://www.ftc.gov/tips-advice/competition-guidance/industry-guidance/health-care.

How do I start sharing my data?

You control your health-related data sharing through health apps, like step and exercise trackers, or through provider office chart applications, which you must choose to connect through your smartphone, tablet, etc. See a list of the healthcare applications here: https://myhealthapplication.com/health-apps/gallery.

How do I stop sharing my data?

If you do choose to share access through your personal devices and want to stop sharing, you must change your preferences on your personal device(s), not at your Member portal or anywhere else on the Community Health Options website.

How do I correct inaccuracies in data that I see in my app?

You must contact the organization or business that created your app to address any inaccuracies in the data displayed by that app. If there are inaccuracies in medical records, billing records, payment and claims records, or enrollment records maintained by Community Health Options, please contact Member Services at (855) 624-6463 for a “Request for Amendment to PHI” form.

An individual is eligible for a Special Enrollment Period (SEP). Do I need to submit anything to enroll them?

We require supporting documentation that outlines the specific SEP and whether the Member qualifies. The required information may vary depending on the nature of the event.

If you are unsure what supporting documents you need to provide, please contact our Member Services Department for assistance at (855) 624-6463, select option 1, then choose option 5.

When will I get my 1099?

1099 Forms are mailed to brokers prior to the end of January each year.

What are your eligibility guidelines for group plans?

To be eligible as an Employer Group, there must be at least one eligible common law employee who is receiving a W-2, who is not an owner or spouse of an owner, and is working a minimum of 30 hours per week. Sole Proprietors and groups composed only of an owner and spouse are not eligible for a group plan and must enroll on the Individual Market. An eligible group must be headquartered in Maine. It cannot have more employees in any other state than are employed in Maine to be eligible for coverage with Community Health Options.

What is the difference between a Small Group and a Large Group?

Group size is determined by the number of Eligible Employees (EEs). An employer with 1 to 49 EEs is considered a Small Group and will be community rated. Any Employer Group with 50 or more EEs during the prior calendar year is considered a Large Group, will receive premium rates based on the group’s claim experience, and will be medically underwritten. Groups with 50 or more EEs may also be considered an Applicable Large Employer (ALE) by the IRS and be subject to specific reporting requirements. Visit the IRS website for more information about determining if your business is an ALE.

How many plans can an employer choose for their employees?

The number and variability of plans you may select for employees to choose from are limited by the number of enrolled employees.

  • 1 – 10 Enrolled Employees: 2 plan options, with no more than a $3500 spread in Deductible
  • 11 – 19 Enrolled Employees: 2 plan options, with no Deductible spread limitation
  • 20 or more Enrolled Employees: 3 plan options, with no Deductible spread limitation

I am taking over an existing Health Options client on a Broker of Record (BOR). What do I need to do?

For commissions to be paid to a new broker who is taking over an existing enrolled employer, the broker must obtain a signed Broker of Record Letter from the employer group. Submit the letter directly to your Account Manager in our Business Development Department to have the change processed.

When do you pay commissions?

Commissions are paid to appointed brokers no later than the end of the month for any commissions earned for the prior month.

What do I do if I have a question on my commissions?

Please email BusinessDevelopmentInfo@healthoptions.org, or call (207) 402-3353.

How do I inquire about becoming appointed with Community Health Options?

Please contact our Business Development Department directly at (207) 402-3353 or email BusinessDevelopmentInfo@healthoptions.org.

Who do I contact if my client has an issue that needs to be resolved?

If you need assistance with an Individual Member, please contact Member Services at 1 (855) 624-6463 then select option 1, then select option 5. For assistance with a Group client, please contact your Account Team in our Business Development Department at (207) 402-3353.

Who do I contact for assistance with the Broker Portal?

Please contact any Account Team member in the Business Development Department at 207-402-3353.

What is interoperability?

Interoperability in healthcare is the ability for information, in the form of data, to be shared and used among doctors, laboratories, hospitals, pharmacies and the consumer/patient. The goal of sharing healthcare data within the health service industry is to create a more effective and efficient means to provide quality care by enabling quicker and more informed decisions.

What does interoperability mean for me?

It is important for Health Options Members to know that you control your health-related data sharing through health applications, like exercise trackers, which you must choose to connect through your smartphone, tablet, etc. If you choose not to share your access – your information remains private. You turn data sharing on and off via your health and wellness application on your personal device. If you don’t download an app and turn on permission, nothing changes.

What do I need to know before I connect an app?

If you choose to connect health care provider or commercial health tracking apps, you are placing a copy of your personal health information/data outside of Health Options' systems and data protections. This information includes, but is not limited to, your name, date of birth, health insurance plan information, healthcare providers you have seen, claims made for medical, pharmaceutical and laboratory visits, and other data.

You must contact the organization or business that created your app for information about how they will protect, share, or sell your data. It’s important to remember that not all organizations or individuals are covered by health information protection (HIPAA) regulations. Read more about HIPAA here: https://www.hhs.gov/hipaa/index.html. To learn more about your rights related to online data access, visit the Office of Civil Rights here: https://www.hhs.gov/ocr/index.html and the Federal Trade Commission here: https://www.ftc.gov/tips-advice/competition-guidance/industry-guidance/health-care.

How do I start sharing my data?

You control your health-related data sharing through health apps, like step and exercise trackers, or through provider office chart applications, which you must choose to connect through your smartphone, tablet, etc. See a list of the healthcare applications here: https://myhealthapplication.com/health-apps/gallery.

How do I stop sharing my data?

If you do choose to share access through your personal devices and want to stop sharing, you must change your preferences on your personal device(s), not at your Member portal or anywhere else on the Community Health Options website.

How do I correct inaccuracies in data that I see in my app?

You must contact the organization or business that created your app to address any inaccuracies in the data displayed by that app. If there are inaccuracies in medical records, billing records, payment and claims records, or enrollment records maintained by Community Health Options, please contact Member Services at (855) 624-6463 for a “Request for Amendment to PHI” form.

Use this form to apply for Community Health Options individual, direct-enroll health insurance coverage or to make changes to an existing direct-enroll policy. It’s important to complete all questions and sign this form before submitting your request. If you have any questions, please contact our Member Services team at (855) 624-6463. Note: Members with policies initiated through the Maine Health Insurance Marketplace (CoverME.gov) must contact the Marketplace to make a change to an existing enrollment.

Use this form to add, remove, or change an enrollment of an employee or dependent in a 2022 enrolled plan. 

Use this form to add, remove, or change an enrollment of an employee or dependent in a 2021 enrolled plan. Contact Business Development at (207) 402-3330 for assistance.

Review this document for a full overview of our 2022 Individual and Family Plans, offered on and off the Marketplace. 

Use this guide to look up information about your plan benefits and how to use them to access care.

For Members who access health insurance through their employer: Use this guide to look up information about your plan benefits and how to use them to access care. Contact Business Development at (207) 402-3330 for assistance.

For Members who access health insurance through their employer: Use this guide to look up information about your plan benefits and how to use them to access care.

Health insurance Open Enrollment takes place every year between November 1 and December 15. Certain qualifying events, such as marriage, birth and moving out of coverage areas, can qualify you for Special Enrollment Period. Use this guide to learn more.

Outside of employer Open Enrollment, certain qualifying events, such as marriage, birth, adoption, or employment status change, can qualify group Members for a Special Enrollment Period. Use this guide to learn more.

Our Chronic Illness Support Program (CISP) is designed to reduce financial barriers for Members with asthma, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), diabetes, hypertension. Learn more about CISP with this document.

Use this guide to get started with Express Scripts, our pharmacy benefit manager. Express Scripts offers online prescription ordering, auto-generated comparisons, suggestions for lower cost prescription options and home delivery.